Update on Constitutionality of Healthcare Lawsuit -DOJ Response

The Federal Government had just filed its motion to dismiss and memo of law in support in the case Attorney General McCollum filed in the Northern District of Florida, Case No. 3: 1 O-cv-91-RV/EMT.  The memo of law is here DOJ MTD Memo 55-1.  Analysis of the points raised in the motion will follow.

The Federal Government summarizes its case as follows:

Plaintiffs’ challenge to the provisions addressing insurance provided to a State’s own employees fails on jurisdictional grounds and on the merits. The plaintiff States currently offer insurance to their employees and plaintiffs do not allege that their insurance plans are inadequate under the ACA. Thus, plaintiffs cannot show that they will be injured by the provisions they challenge. In any event, it is settled that Congress may impose on State employers the same type of requirements that it imposes on private employers. Garcia v. San Antonio Metro. Transit Auth., 469 U.S. 528 (1968).

Plaintiffs’ challenge to the minimum coverage provision likewise presents no case or controversy. The provision will not take effect until 2014, and it is entirely speculative whether the individual plaintiffs will be injured. The States and the National Federation of independent Businesses have no standing to challenge this provision either. And the Anti-Injunction Act bars injunctive relief against payment of a tax penalty. See 26 U.S.C. (I.R.C.) § 7421.

Even if plaintiffs had standing to challenge the minimum coverage provision, the challenge would fail. The minimum coverage provision is well within Congress’s authority under the Commerce Clause. Congress rightly understood, and plaintiffs do not deny, that virtually everyone at some point needs medical services, which cost money. The ACA regulates economic decisions about how to pay for those services – whether to pay in advance through insurance or attempt to do so later out of pocket – decisions that, “in the aggregate,” substantially affect the $2.5 trillion interstate health care market. Gonzales v. Raich, 545 U.S. 1,22 (2005). Among other things, Congress found that these economic decisions shift costs to third parties, ACA §§ 1 501 (a)(2)(F), 10106(a); “increas[e] financial risks to households and medical providers,” id. §§ 1501(a)(2)(A), 10106(a); raise insurance premiums, id. §§ 1501(a)(2)(F), 10106(a); precipitate personal bankruptcies, §§ 1501 (a)(2)(G), 10106(a); and impose higher administrative expenses, id. §§ 1501 (a)(2)(J), 10106(a). Congress determined that, without the minimum coverage provision, the reforms in the Act, such as the ban on denying coverage based on pre-existing conditions, would not work, as they would amplify existing incentives for individuals to “wait to purchase health insurance until they needed care,” shifting even greater costs onto third parties. Id. §§ 1501(a)(2)(I), 10106(a). Congress thus found that the minimum coverage provision “is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold.” Id. Congress also concluded that requiring the financially able to purchase insurance would spread risks across a larger pool and lower premiums. Id. §§ 1501(a)(2)(I), 10106(a). Congress’s authority under the Commerce Clause and Necessary and Proper Clause to adopt the minimum coverage provision is thus clear.

In addition, Congress has independent authority to enact this statute as an exercise of its power under Article I, Section 8, to lay taxes and make expenditures to promote the general welfare. License Tax Cases, 72 U.S. (5 Wall.) 462, 471 (1867). The minimum coverage provision – in particular, the requirement in the Internal Revenue Code that individuals pay a tax penalty if they do not have the requisite coverage – will raise substantial revenue. The Supreme Court has long held that an exercise of this power is valid even if it has a regulatory function, even if the revenue purpose is subsidiary, and even if the moneys raised are only “negligible.” United States v. Sanchez, 340 U.S. 42, 44 (1950). It is equally clear that a tax predicated on a volitional event – such as a decision not to purchase health insurance – is not a “direct tax” subject to apportionment under Article I, Sections 2 and 9. United States v. Mfrs. Nat ‘I Bank of Detroit, 363 U.S. 194, 197-98 (1960); Tyler v. United States, 281 U.S. 497, 502 (1930).